Manual Blood Pressure HELP

Lev, MSN, RN, NP · Oct 13, 2016

Maybe their systolic blood pressure really is at 160. Many people do walk around with a high blood pressure even if they seem ok. Next time you take a blood pressure, palpate for a radial pulse while you pump up the cuff and watch the dial. At the point where the pulse disappears is the approximate systolic blood pressure. (When you hear a blood pressure of 70/palp this is the technique that was use or a doppler was used to auscultate for the pulse). Once you get the approximate systolic blood pressure re-inflate the cuff and listen for the tapping sounds with your stethoscope.

nursej22, MSN, RN · Oct 13, 2016

Everything that Lev says. Hypertension is called the "silent killer" because people often don't know they have it until organ damage has occurred.

Some other tips: be sure that the client's arm is stabilized on a firm surface, or support it with your arm that is closest to the client. The cuff needs to be high enough on the arm so that it is not touching the stethoscope, and the stethoscope needs to be flat over the brachial pulse point. Try to avoid placing your thumb on the head of your stethoscope; sometimes you will hear your own pulse from your thumb.

Squidney · Oct 14, 2016

Maybe their systolic blood pressure really is at 160. Many people do walk around with a high blood pressure even if they seem ok. Next time you take a blood pressure palpate for a radial pulse while you pump up the cuff and watch the dial. At the point where the pulse disappears is the approximate systolic blood pressure. (When you hear a blood pressure of 70/palp this is the technique that was use or a doppler was used to auscultate for the pulse). Once you get the approximate systolic blood pressure re-inflate the cuff and listen for the tapping sounds with your stethoscope.[/quote']
Hello! Thanks for replying! I know that the people I did it with didn't have ~160 for their systolic since they were my classmates and they usually don't have it that high. Neither did they had any syptoms or signs that would explain why they'd have 160 for systole on the days I practiced with them so I am pretty positive I was doing it wrong.
It always seems I am hearing different noises before the actual systolic sound and I am having a hard time distinguishing which of the noises/sound is the actual systolic sound. Would you happen to know any tip on properly distinguishing the systolic sound from the other noise? Thanks again!

Squidney · Oct 14, 2016

Everything that Lev says. Hypertension is called the "silent killer" because people often don't know they have it until organ damage has occurred.
Some other tips: be sure that the client's arm is stabilized on a firm surface, or support it with your arm that is closest to the client. The cuff needs to be high enough on the arm so that it is not touching the stethoscope, and the stethoscope needs to be flat over the brachial pulse point. Try to avoid placing your thumb on the head of your stethoscope; sometimes you will hear your own pulse from your thumb.

Hi! Thank you for replying!

I really appreciate your tips, but unfortunately, I am still hearing different noises. Sometimes I would hear light, irregular taps before I actually hear the clear thumps that I am familiar with. In this case, do I record the first light, irregular tap or the first clear, regular thump?

Sometimes I hear swooshing, too. What could that be?

All these happened and still happen to me with different 'patients' so I figured I am the one with the problem haha.

Also, for counting the radial pulse, I experienced a few instances where the pulse stopped for about 5 seconds then came back a lot fainter and a little bit irregular. Like, if I take the pulse for 30 secs, I'd feel the pulse, regular and quite strong, for the first 15-20 secs then I will lose it for the next 5-7 seconds, then it'd come back really faint and the pulse now is irregular. What is happening? Am I doing anything wrong? I would really appreciate tips on this as well! Thank you!d for about 5 seconds then came back a lot fainter and a little bit irregular. Like, if I take the pulse for 30 secs, I'd feel the pulse, regular and quite strong, for the first 15-20 secs then I will lose it for the next 5-7 seconds, then it'd come back really faint and the pulse now is irregular. What is happening? Am I doing anything wrong? I would really appreciate tips on this as well! Thank you!

Lev, MSN, RN, NP · Oct 16, 2016

Blood Pressure Assessment: Overview, Indications, Contraindications

Lev, MSN, RN, NP · Oct 16, 2016

Hello! Thanks for replying! I know that the people I did it with didn't have ~160 for their systolic since they were my classmates and they usually don't have it that high. Neither did they had any syptoms or signs that would explain why they'd have 160 for systole on the days I practiced with them so I am pretty positive I was doing it wrong.
It always seems I am hearing different noises before the actual systolic sound and I am having a hard time distinguishing which of the noises/sound is the actual systolic sound. Would you happen to know any tip on properly distinguishing the systolic sound from the other noise? Thanks again!

Any sound you hear can be systole. It starts off loud and then softens. Just listen for when the sound starts. You should feel for when the pulse disappears before taking the blood pressure like I mentioned to determine when systole starts. This is how I was taught in school. Also, you may find it easier to stick the head of the stethoscope under the cuff and let the blood pressure cuff hold it in place instead of holding the stethoscope and risking the sounds of you touching it confusing you. P.s. just because they are your classmates does not mean they can't have a BP of 160. She could be very anxious. Not everyone is symptomatic with a BP of 160. Thinking like that is - i.e. if you don't expect something to be there it's not there" AKA tunnel vision - trips up a lot of new graduate nurses. Seeing the abnormals without justifying that it can't be so even when the patient "was just fine an hour ago" is something that all new nurses must learn.

BrendanO, MSN, RN · Oct 16, 2016

How different are the pressures between when you hear the light taps and the louder thumps? Normally, systolic would be measured at the first audible Korotkoff sound. The problem is to determine whether the first thing you're hearing is a Korotkoff sound or not. Have you tried just putting the stethoscope on the brachial pulse point with a totally deflated cuff (so you should hear nothing), to see whether you're hearing something unrelated to the patient's pulse?

There can be normal (but typically small) variation in pulse rate and rhythm and BP caused by breathing/ventilation. This should not normally cause total loss of palpable radial pulse, though. The next time you are noticing those irregularities, see if they correspond at all with the patient's breathing.

The swooshing might be Korotkoff Phase II or IV sounds. I've never really heard them clearly (my hearing's not that acute); I rarely hear anything but the main taps/thumps.